Scotland moves ahead with ending NHS top-up ban

The Scottish government has produced draft guidance covering circumstances where National Health Service patients should be able to top-up their treatment with privately-purchased drugs without forfeiting their NHS care.

The draft revised guidance, which has gone out to Scotland’s NHS Boards for consultation, “seeks to combine the rights of the individual with robust clinical governance and the founding NHS principle that treatment should be based on clinical need, not on the ability to pay, with NHS care free at the point of access,” the government says.

According to the draft, the key requirements which should apply in such circumstances are that:- the primary purpose of any NHS organisation is to provide NHS care;- NHS and private care should be kept as clearly separate as possible and, in all cases, it must be clearly understood by all parties involved whether an individual procedure or treatment is privately funded or NHS funded;- the NHS should never subsidise private care with public money, which would breach core NHS principles;- private care should be carried out at a different time and place to the NHS care being provided. This could include the facilities of a private healthcare provider, or part of an NHS organisation which has been designated for private care, including amenity beds; and- the fact that some NHS patients also receive private care separately must not be used as a means of downgrading the level of services that the NHS offers.

“We are some way forward already in ensuring that we can improve arrangements here in Scotland,” said Nicola Sturgeon, Scotland’s Secretary for Health and Wellbeing but, she added: “nothing in the new draft guidance should distract us from the priority of making sure that where a patient can genuinely benefit from a drug they are able to access it on the NHS. We must aim to ensure that decisions on co-payments are the exception not the norm.”

In September, Ms Sturgeon announced the government’s intention to revise current guidance “in order to provide greater clarity for NHS Boards,” following the inquiry by the Scottish Parliament’s Public Petitions Committee into access to cancer medicines.

Following the inquiry, the Minister wrote to the Committee’s convener, Member of the Scottish Parliament Frank McAveety, stating that its findings had “highlighted that much in the current system is working well and ensures that, in Scotland, all new drugs receive early consideration by the Scottish Medicines Consortium and that NHS Boards ensure that drugs recommended by the SMC are made available on an equitable basis and in line with the clinical needs of patients. However, I remain keen to ensure where there is scope to develop and improve the current system that appropriate action is taken.”

The government is requesting responses to the revised draft guidance from NHS Boards and other stakeholders by January 12.